Menière's disease

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Abstract
Patients who, at surgery, were found to have their endolymphatic duct region destroyed by an extensive cholesteatomatous process are described. These patients did not suffer from symptoms belonging to Meniere''s disease or the like. The pathogenesis of Meniere''s disease is considered to be due to a disorder or malabsorption of endolymphatic fluid from the endolymphatic sac, which supposedly results in the accumulation of an excessive amount of endolymph. The condition termed endolymphatic hydrops, i.e., histologic distension of the saccule and Reissner''s membrane, is found in autopsies of Meniere''s patients and is attributed to malabsorption of endolymph. Support for this theory comes from the successful creation of a similar histological picture by tampering with the endolymphatic duct, X-ray evidence of a narrowing of the endolymphatic duct, amelioration of hearing after the injection of glycerol and remission after shunt operations. Histological hydrops was also created by many other kinds of experiments, unrelated to the endolymphatic duct, on the external, middle and inner ear. The histological picture considered typical for Meniere, i.e., the hydrops, was found in a multitude of diseases other than Meniere. Apparently, the histological features of hydrops are not really specific for Meniere''s disease, but may be the non-specific end result of diverse insults to the ear. Both the glycerol test and X-ray evidence showing narrowing of the duct were also challenged. As to the shunt operation, its success rate is probably as high as any of the many treatments of Meniere''s disease advocated through the years, or indeed as that of spontaneous remission. The critical physiological and pathophysiological role supposedly played by the endolymphatic duct and sac should be reviewed. The evidence at hand that Meniere''s disease is either secondary to hyper-pressure or secondary to malabsorption of the endolymphatic fluid by the endolymphatic duct and sac, is probably not conclusive. Although many interesting data (experimental and otherwise) was gathered in the last generation concerning the inner ear and Meniere''s disease, the essential pathogenetic nature of the disease is still unknown.

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